Drugs for pain surge in Florida

The state's climb in retail painkiller sales is 10th highest - for lack of laws, some say.

By the Times staff and wire services
Published August 21, 2007

ADVERTISEMENT [AP photo] Laura Krietemeyer, a neurologist who suffers from chronic pain brought on by neurofibromatosis, is seen at her house in Dublin, Ohio.

Retail sales of five leading painkillers nearly doubled over an eight-year period, reflecting a leap in use by patients nationwide, according to an Associated Press investigation.

Sales of codeine, morphine, oxycodone, hydrocodone and meperidine rose 90 percent from 1997 to 2005, the analysis of Drug Enforcement Administration data revealed.

Florida reported a 142 percent increase, the 10th highest in the nation. South Pinellas County showed an overall increase of 260 percent and led the state in the percent increase in hydrocodone and oxycodone.

The AP investigation, which controlled for population growth, found several reasons for the nationwide increase.

• The population is getting older. As age increases, so does the need for pain medications.
   
  
• Drugmakers have embarked on unprecedented marketing campaigns. Spending on drug marketing has zoomed from $11-billion in 1997 to nearly $30-billion in 2005.
   
  
• A major change in pain management philosophy is now in its third decade. Doctors who once advised patients that pain is part of the healing process began reversing course in the early 1980s. Most now see pain management as an important ingredient in overcoming illness.

Whatever the reason, some of the drugs are winding up in the hands of dealers and abusers, especially in Florida.

While more than 30 other states have taken steps to monitor the legal sale of heavy-duty painkillers, efforts to establish a central monitoring system in Florida have failed, largely because of privacy and cost concerns.

Monitoring systems have significantly clipped the diversion of prescription drugs into the black market in several states. But Florida's lack of a monitoring system has attracted drug dealers, authorities said.

A centralized monitoring system, in which doctors and pharmacists can track prescriptions in a database, would help target doctor shopping, a common practice by drug abusers, said Tampa Bay law enforcement officials.

"It would be a great tool," said Capt. Michael Platt, commander of the Pinellas Sheriff's Office narcotics section. "It would give us insight into who's doctor shopping."

This year, the Legislature passed a watered-down version of a bill that established a voluntary monitoring system. It does not require doctors and pharmacies to participate, said Dr. Rafael Miguel, a Tampa pain specialist who has been pushing for a statewide directory for five years.

"It's toothless," Miguel said. "We need controls at the candy store. We need controls at the pharmacy. It would make doctor shopping largely a thing of the past."

Some advocates for pain patients believe monitoring systems and other government programs make it harder for legitimate pain patients to get the prescription pills they need.

The DEA has prosecuted more than 100 doctors in the past four years, several on charges they prescribed pills that led to patients' deaths. Some pain patients say this has made doctors reluctant to prescribe painkillers to truly suffering patients.

But Miguel said a monitoring system would increase availability to the truly sick.

"I think it would make doctors more confident that the person they are prescribing to is the intended recipient," he said. "They are more confident that who they are prescribing to is not a drug dealer."

Tampa Bay law enforcement officials say prescription drug Web sites - some of which require no doctor consultation - also have become a favorite source for drug dealers and abusers. Several have been busted in South Florida.

As the use of painkillers has increased, so have the number of deaths attributed to them.

According to Florida Department of Law Enforcement reports, oxycodone - the chemical found in Oxycontin and Percocet - caused an average of 341 deaths a year in Florida from 2000 to 2006. Hydrocodone, commonly sold as Vicodin, was to blame for an average of 196 deaths a year in the same time period.

Oxycodone use jumped nearly sixfold nationwide from 1997 to 2005. The drug gained notoriety as "hillbilly heroin," often bought and sold illegally in Appalachia. But its highest rates of sale now occur in places such as suburban St. Louis and Fort Lauderdale.

The world of pain extends beyond big cities and involves more than oxycodone.

In Appalachia, retail sales of hydrocodone - sold mostly as Vicodin - are the highest in the nation. Nine of the 10 areas with the highest per-capita sales are in mostly rural parts of West Virginia, Kentucky or Tennessee.

Times staff writer Chris Tisch contributed to this report and can be reached at tisch@sptimes.com or (727) 892-2359.

[Last modified August 21, 2007, 02:23:27]